American Academy of Podiatric Sports Medicine Application for Advancement to Fellow

Transcription

1 American Academy of Podiatric Sports Medicine Application for Advancement to Fellow Purpose of Fellowship: To encourage high standards of professional responsibility and service to the Academy. To promote and encourage a continuing program of professional development. To recognize professional achievement and competence in podiatric sports medicine. To recognize the candidate who exhibits a deep and ongoing interest and dedication to the goals and long-range activities of AAPSM. Fellow-applicants should demonstrate each of the following: 1. A high level of competence and ethical conduct with knowledge of the principles and practices of podiatric sports medicine. 2. Active participation in the Academy by attendance at the AAPSM meetings; presentations of papers; peer and public education. 3. A desire to become more active in the internal affairs of AAPSM, including serving in a leadership capacity. An applicant should NOT consider Fellow Status for personal gratification or enhancement. Checklist for Applicants The following requirements must be met: "Shall have earned a diploma from an accredited college of podiatric medicine (DPM)" "Shall be a member in good standing of the American Podiatric Medical Association (APMA)" (if a podiatrist) "Shall have been a member of the American Academy of Podiatric Sports Medicine (AAPSM) for three consecutive years at the time of application for advancement, OR, shall have completed an AAPSM-approved Podiatric Sports Medicine Fellowship" "Shall have demonstrated high standards of professional development and commitment to the goals and long-range activities of the Academy: *Must attain a minimum total score from Section 4 of the Application of 15 points" 30 points. "Shall have received a letter of recommendation by an AAPSM Fellow or affiliated sports team professional (team physician, etc.) "Shall have submitted a curriculum vitae, including evidence that he or she has fulfilled the requirements of the Academy" **Upon acceptance of the above requirements, Shall achieve a minimum passing score of 75% on: 1. Written Examination (this take-home exam will be sent to you after acceptance of your completed Fellow Application) 2. Present a 5 slide/5 minute presentation either in person at determined site or by video/skype conferencing The following must be mailed to the AAPSM Headquarters before the May 1 deadline: Completed application and all supporting material and attachments. Curriculum vitae Recommendation for Advancement to Fellowship. The processing fee of $250. Applications can not be processed without this fee. Page 1

2 Return to: American Academy of Podiatric Sports Medicine Questions? Fellow Credentials Committee Call NE 26th Street or Ocala, FL Page 2

3 This Application Must Be Typed or Printed Neatly American Academy of Podiatric Sports Medicine Application for Advancement to Fellow Please submit a $250 processing fee with your application. Complete the entire form. If space is not adequate, attach additional sheets. Name: Highest degree earned: Date received: Year joined AAPSM: Consecutive years as an AAPSM member: (Must be at least 3 years) Have you completed an AAPSM-approved Fellowship-in-training program? Yes / No If yes, name of program: Are you Board Qualified? Yes / No If yes, Which Board? Are you Board Certified? Yes / No If yes, Which Board? List the AAPSM Annual Meetings that you have attended (Year and Location) List the AAPSM-Fellow who will be writing a recommendation on your behalf: 1 Education (List most recent degree first): Institution Degree Institution Degree Institution Degree 2 Post-Graduate Internships, Residences, Fellowships, Special Certifications, etc. Experience Experience Page 3

4 Experience Please be as specific as possible when responding to the following questions in order for the Credentials Committee to thoroughly review your application. The statement "refer to c.v." is not sufficient. 3 Professional Experience and Employment (Positions held - list most recent first) Page 4

5 4 Service to the American Academy of Podiatric Sports Medicine and to the sports medicine community A) Professional Presentations Value Present a lecture or workshop at an AAPSM-sponsored meeting (4 points; 8 if presented at more than one sponsored meeting) The MINIMAL requirement for service can be met by any combination of items listed below. Total points must add up to a sco at least 30 points Applications are encouraged to document as many points as possible. Contact Rita Yates for additional "points" assignments Presented a lecture or workshop at an AAPSM-sponsored podiatry school meeting (3 points; 6 points if presented at more than one school meeting) Present a case presentation/study at any AAPSM-sponsored meeting (2 points per case; 4 points maximum) Presented a sports medicine lecture at a national or international meeting such as ACSM, ACFAS, APMA, NATA, PFOLA, Podiatry Institute, etc) (2 points; 4 points if presented at more than one meeting) Conducted a sports medcine tutorial/grand rounds/lectures/labs/workshops in a clinical or educational seting (2 points per talk; 6 points maximum) B) Publications and Reviewers Value Written a published book on a sports medicine topic (6 points) Contributor to a published sports medicine book (3 points; maximum 6) Published a sports medicine article in a peer-reviewed journal such as JAPMA, JFAS Clin Pod. Med., Foot Anke Int., etc. (4 points) Submitted a case review for publication in the AAPSM Newsletter (3 points; maximum of 6 points) Submitted a Journal Review article in the AAPSM Newsletter (3 points each; maximum of 6 points) Responded to a Pearl in the AAPSM Newsletter (2 point each, maximum of 6 points) Published a sports medicine article in a magazine such as Podiatry Management, Podiatry Today, Biomechanics, etc. (3 points) Published a sports medicine article in a lay publication such as a running club newsletter, newspaper, or magazine (2 points) Served as a reviewer for a peer-reviewed journal focused on a sports medicine (2 points) C) Clinical and Lay Service Value Served as State Level Clinical Director for Fit Feet (Special Olympics) (6 points) Volunteered for Fit Feet Special Olympics event (3 points - 6 points maximum) Completed a full term of service - at least 1 year - on an AAPSM Committee (5 points) Served as a team physician/consultant for any community, high school, collegiate or professional athletic team for at least 2 years (5 points) Volunteered as a member of the medical team for a sporting event or running event (4 points) Page 5

6 Volunteered at a pre-season physical screening, health fair, or other free screening (2 points) Established a permanent education service to the community in the area of sports medicine (e.g. TV program, newsletter, etc) (2 points) Published a sports medicine article in local newspaper (1 point per article; 3 points maximum) Presented a sports medicine lecture to the lay public; group, organization, school, etc (1 point per talk; 3 points maximum) Total Points = A+B+C (Must be at least 30 points) Page 6

7 5 Describe your clinical and/or professional practice involving sports medicine. 6 Describe in 100 words or less why you: a- would like to be an AAPSM Fellow and b- should be approved for the advancement to Fellow Status. 7 If advanced to Fellow status, how do you intend to exhibit your dedication to the goals and activities of the Academy? For example, on which committees would you like to serve or chair? Be as specific as possible. Page 7

8 **IMPORTANT** Once Fellow Status has been achieved, it must also be maintained - every 5-year period - by either of the following: 1- Attending at least one AAPSM-sponsored meeting/ function, or 2- Assisting at a pre-approved AAPSM sponsored event (such as Special Olympics) 3- Writing Journal Reviews for the AAPSM newsletter Page 8

9 American Academy of Podiatric Sports Medicine Advancement to Fellow Recommendation Form Please type this recommendation form Please return your recommendation to: American Academy of Podiatric Sports Medicine Credentials Committee 3121 NE 26th Street, Ocala, FL Page 9